Gastrointestinal: Gastric mucosa‐associated lymphoma presented with unique vascular features on magnified endoscopy combined with narrow‐band imaging

Abstract

Gastrointestinal: Gastric mucosa-associated lymphoma presented with unique vascular features on magnified endoscopy combined with narrow-band imagingGastric lymphoma arising from mucosal associated lymphoid tissue (MALT) has distinct clinical and histological characteristics compared with nodal B-cell lymphoma. Magnified endoscopy (ME) combined with narrow band imaging (NBI) is widely used and the usefulness is well recognized for the diagnosis of gastritis and gastric cancer. However, there has been no report on ME combined with NBI for gastric MALT lymphoma, despite the necessity of differentiating it from gastric cancer. We report a case of gastric MALT lymphoma in which ME combined with NBI could detect unique vascular features different from those seen in circumscribed atrophic gastritis or poorly differentiated adenocarcinoma.A 66-year-old woman underwent endoscopic screening of the upper gastrointestinal tract revealed ill-defined, brownish, superficial depressed lesion in the anterior wall of the upper gastric body (Fig. 1). ME combined with NBI system, consisting of an image processor (CV-260SL, Olympus Medical Systems, Tokyo, Japan), a light source (CLV-260SL), and a zoom endoscope (GIF-Q240Z) showed the disappearance of the surface structure and the appearance of abnormal blood vessels. Abnormal vessels were defined as new vessels that were not seen in the adjacent mucosa. They were large vessels like a tree trunk with long, bare branches that can be called as 'tree like appearance' (Fig. 2). Biopsy was taken from this abnormal portion and revealed hyperplasia of atypical centrocyte-like cells with small to medium-sized, ovoid nuclei and clear cytoplasm in the lamina propria mucosae and their infiltration among glandular epithelial cells, suggesting lymphoepithelial lesion. The atypical lymphocytes were immunohistochemically CD20+, CD10-, and CD5-. These findings were consistent with gastric MALT lymphoma.In this case report, we have shown that the tree-like appearance of the abnormal blood vessels, clearly observed by ME with NBI, could be one of the unique features suggestive of gastric MALT lymphoma. This finding could be helpful because superficial depressed type lesion potentially include circumscribed atrophic gastritis and poorly differentiated adenocarcinoma. Of note, these vascular findings are relatively easy to detect by using NBI, because NBI can present clearly defined vascular image. Therefore, our data also suggest the importance of NBI for the endoscopic evaluation of gastric MALT lymphoma. The combination of ME with NBI may also reduce the number of biopsy of gastric MALT lymphoma because it can provide precise information about the distribution of MALT lymphoma in the stomach.

The Progression of Esophageal Mucosa-associated Lymphoid Tissue Lymphoma after <i>Helicobacter pylori </i>Eradication Therapy: A Case Report and Discussion of Therapeutic Options

“…In a recent report that reviewed 14 patients with esophageal MALT lymphoma, the endoscopic findings of 11 patients showed submucosal tumor-like lesions; nine of these had craniocaudal extension (22). The present case showed both of these endoscopic findings, and we additionally observed the presence of abnormal blood vessels similar to a tree-like appearance, which is a typical characteristic of gastric lesions in MALT lymphoma (39, 40). This characteristic was recently reported in an esophageal lesion by Kudo et al (25).…”

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

“…In addition, H. suis -associated gastric MALT lymphoma was recently documented to have a nodular gastritis-like appearance, which is distinct from the common type [ 63 ]. The endoscopic findings on narrow band imaging (NBI) magnifying endoscopy were also characterized by a tree-like appearance (TLA), which corresponded to abnormally large vessels resembling a tree trunk with long, bare branches [ 64 ]. Moreover, endocytoscopy may be useful for detecting intra-glandular aggregation of cellular components and small to moderately sized nuclei in gastric MALT lymphoma, but further studies are needed [ 65 ].…”

Endoscopic Diagnosis of Gastric MALT Lymphoma

“…In 2009, we reported a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma presenting with unique vascular features [12]. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost (Figure 3).…”

“…There are few organized reports on the endoscopic findings of gastric MALT lymphoma [6]- [8], with only a few case reports published on its diverse endoscopic findings [9]- [11]. Recent studies have reported the useful-ness of NBI magnifying endoscopy in diagnosing gastric MALT lymphoma [12]- [15]. In addition, the usefulness of endoscopic ultrasound findings as a predictor of the therapeutic efficacy of H. pylori eradication has been reported [16] [17].…”